BBA Spring 2019 Basketball Registration

* Required Fields
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You may register one or two (siblings) on this form.
Registration fee for one child is $600
Registration fee for the second child is $400
You may choose to pay all fees at time of registration or you may choose to pay 50% now and the remaining balance within 30 days.  Your child will not be allowed to play if the fee is not paid in full.
 Pay full amount one child (+$600.00)
 Pay half of fee now - bill me for balance due (+$300.00)
 Pay full amount 2 children (+$1,000.00)
 Pay half of 2 child fees now - bill me for balance due. (+$500.00)
Participant #1 Registration 
*Player First Name
*Player Last Name
*Current Age
*Birth Date
*Current School (use shortest name possible!)
*Jersey Size
*Shorts Size
Medical conditions? If so, please let us know.
Any food allergies? Please list all!
Second Child Registration
Player #2 First Name
Don't type in this field
Player #2 Last Name
Current Age
Birth Date
Current School (use shortest name possible!)
Jersey Size
Shorts Size
Medical conditions? If so, please let us know.
Any food allergies? Please list all!
Parent/Guardian Information
*Parent/Guardian #1: Name
*Email Address
*Cell #
Parent/Guardian #2 (Name)
Email Address
Cell #
Medical Release
As a parent or guardian of the above named player(s), I hereby give my consent for emergency medical care as prescribed by a doctor or dentist to my dependent. I, the parent or guardian, agree that my child and I will abide by the rules of the Birmingham Basketball Academy's Spring 2019 Program. I furthermore hereby release, discharge, and or otherwise indemnify the league, administrators, & coaches against any claim by or in behalf of the registrant as a result of their injury in the program.
*Waiver Agreement
I have read and agree with the waiver. 
*Does your family have health insurance?
Total Due:
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